Cardiac Monitors Detect Few Events and Sound Many False Alarms

Continuous electrocardiographic monitoring is a sacred cow in emergency medicine, despite little evidence of efficacy. In a prospective observational study, these authors assessed its utility among patients who presented to a single Canadian emergency department with nontraumatic chest pain of possible ischemic origin.

The decision to monitor was made by the treating clinician. Patients with hemodynamic instability or initial ECG findings diagnostic of ischemia or arrhythmia were excluded. Of 87 eligible patients, 71 completed the study. The main outcome measure was the rate of adverse events (arrhythmias or changes in vital signs requiring intervention) that were detected by monitoring.

Using three previously validated risk-stratification to…